Broken Sterile Technique?

[nurse deb]

Hi, I decided to go ahead and ask this question since everyone gives such good advice here. My Dad resides in New Orleans and has numerous medical problems. His neuro status has been declining rapidly over the years. He had a MI and a couple TIA's years back. He also has Crohn's and enlarged prostate. Due to the urinary frequency and such, he was given an indwelling urinary catheter. It took him some getting used to. I think the home health RN had orders to change the catheter q month. He seems to be doing well so far.

The reason I'm writing this is because a new home health nurse (an LPN like myself) came out today to change his catheter. My Mother related to me that the nurse had some difficulty getting past his prostate at first. Then the nurse realized that she wasn't IN the urinary meatus, but pushing under the foreskin!! He's in his late 60's and was never circumcised, but how can you miss the urinary meatus on a male? I asked my Mother if she obtained a sterile catheter after pushing under the foreskin and she didn't know. God, I hope so!

Anyway, if the nurse admits to using a contaminated catheter, what is the usual course of action or protocol. Would they put in a new cath and give him po antibiotics or what? I'm worried about him. I'm 12hrs away and I'm upset about her possibly giving my Dad a serious infection. These are supposed specialists in this field and yet she admits to having very little experience doing male pts, especially uncircumcised! What do you think? I'm upset that an she was allowed to do this. Why wasn't she ever oriented or followed by her RN supervisor on her team to make sure she knows proper technique? This is exactly the kind of thing that gives LPN's a bad name.....ugh.

Deb

[P_RN, ADN, RN]

I have seen people do this and called them on it right then.

She should have used at least a new catheter even if the same kit is used.

I'd say call her agency and relate just what you have told us here. Perhaps they can send a different nurse.

[nurse deb]

Also, I could be wrong. My Mother's going to ask her about it tomorrow and she feels this nurse will be 100% honest about whether or not she obtained a sterile catheter. I'm not so sure? We'll see.....

Deb

[nurse deb]

That's what I told my Mom. All she needed was a new, sterile cath and a pair of sterile gloves. I've seen it happen before too, that's why I'm worried. My Mom had no idea because she's never had any medical training. They're paying good money to have professionals come out and take care of him.

[nurseman]

Even if the nurse says she got a new catheter I'd still get your mother to monitor your fathers urine and report any changes in clarity or increased smell to his MD. (It would probably be a good idea to have her do that as a matter of routine if she doesn't do it now.) I don't know if your parents would have to pay for lab tests or if they have insurance to cover it but a C&S of his urine could ease your fears.

If the nurse admits to having little experience in giving uncircumcised males catheters then I'd call the agency and request that they send someone to supervise her next visit to insure that she is doing it correctly.

[MPHkatie]

Sterile technique is a basic nasic skill of nursing, so basic in fact that Nurse Aides (level two) are certified to insert urinary catheters. But mark my words, the nurse will never admit to using anything but a new sterile catheter, no matter what Mom thinks. I think it would be career suicide, because she should know better and there really is no grey area, nor is this some sort of special thing not taught in school. I have seen difficult cath's due to moving patients etc when sterile technique was questionable, but this doesn't sound like the case. I must agree, if the nurse feels like she doesn't have experience, she needs some assistance, as she may do something more permanent next time, such as retract the foreskin and leave it....

[Teshiee]

I had to take care of a quadriplegic and when we cath the patient we did not use sterile catheter but a clean one. Homehealth and acute care is so different. Realistically you should use sterile I think it is more of a cost factor why sterility may be compromised.

[km rn]

Please check into why the catheter is being changed every month.

We no longer change catheters every month - it increases the risk of infection. We change catheters if we need to get a urine culture, if the catheter feels granuley or it there are any concerns with blockage, etc.

Frequently patients and families are taught to self-cath or catherize using a "clean" technique. Overall these patients seem to do quite well. There would be a different standard of care expected from a licensed professional than a lay person.

Call the agency and discuss your concerns with the DON.